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FUK OFFICE USE: ------------------------ --------------------------------- - ----------------------------------------- ------- r APPLICATION FOR SANITATION PERMIT Permit No, ---------- -_1------ ------ ----- ---------------------- I a (complete in Duplicate) ---------- -------------------- ---------Z-------- This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San 1?a n.kQcf6l,HeaI+h District for a per if to constructi d install the work herein deqCr.k,%ed. T F— ance uhty,�Rrclinance No, 549. :i� 's application is made in compli t "N JOB ADDRESS AND �'s LOCATION-------- ------------ -------------------- ..... ........ -------------------- ----I-------------------------- Pone Owner's Name--------------- 7- !------- -------- Ph Address-------------------- - ------ --------1. -- ---------- ------ ---------------- Contractor's Name--- l' k -------------------- ---------------- Phone.---------------------------------- Installation will serve: Residence �Apartment House E] Commercial E] Trailer Court E] Motel; EI Other'E] l Number of living units: __/----'Number of bedrooms 3- TKber of bath ---L- Lot lsizfe ------ Water Supply: Public.system"[] Community system ZVRriv.&te-n.Eflj Depth to Water Table V__ ft. Character of soil to a depth of 3 fe:et: Sand E] Gravel E] Sandy Loam lay Loam{Lj Clay El Adobe E] Hardpan El Previous Application Made: Ilf yes,'date-------- ------- .-} No 2-- New Construdion: Yes No EEJ F A/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _wtNo-septic tank.or cesspool p,ermitted 4public'sewer_is-a'vailabl im-2 I DO qdf.),2. Septic Tank: Distance from nearest well___?-----Dist,ance from foundation------------ Mate/i i:--_----- E�r No. of compartments___-_2-- -------- - ---Size___,4/XJ_0_,X,57_L,q.;d depth- 2-L-1-_Iapacity-IZ-66,- Disposal Field; Rist ce from nearest well----5;P_._._Disfance from foundation-----_. ----LIDisfance to nearest lot line----- Num"ber of lines' I----------------------------------Length of each line----,100_---e t.wiath of tre n c h�------2 ... .......... Type of filter material.-4RO-Ci<.....Depth of filter mate.rial------/T -----I--;Total W I Seepage Pit: Distance to nedresf well-----------------------Distance from foundation---------------fAlDistance foilnelaresf'lof line..-___-----❑ Nurr�Cber of pits- Lining material---`------------------Size: Diameter!; I - ---------Depth---_----------------- ",pf h--- ------------------ f------------------- ------------ material-__..--...-.--..---_._---.----_-____-. � I ----- Cesspool: Distance from nearest well-------------- --Distance from foundation--------------- Lining material-------_----------------------- ❑ SizeA.Diameter--------------- ----------------------Depth-.-- -i city- -------------------- -----gals.---- ------------------------ ------------Liquid Capllc-- ------------------------- ------- ----- Privy: Disfance from nearest well------------- --------- ------- --Distance from laresf building_ __ ---------- ❑ Distance to nearest lot 1ine ------- --------------------------- ----- ---------- - i;;w-- ------------------------------------ --------- ------------- ----------------------f --- % I Remodeling and/or repairing (describe�----- ;�-, -J, I V2.0- ----------------- --- ------- ------------------------------------------------------- ----------------------------------------0 1 V� P------------------- --------- --------------------- ---------------- ---- ------------ ----------------------- :4-a ---------------- ----------------------------- ---- ---------------------------------------- --------------- - - ---------------------------------=t==-----------------------------------to--46:4-a-— ------------------------------- ---------- ---------------- -------------------- ------------------------- - i -- ---------------------------------------------------------------------------------------------------------- ------------------------------------ 4 �t I hereby certify that.1 have prepa ed this application and fh-at the work will be done in accordance with San Joaquin County ordinances, St to laws. �6hd'.rules a d ,gula ions of the San Joaquin Local Health District. (Signed, --------wft� ------:7_�- --------------- ------- - ---------------------------------------------- �1/ ----------------------------------(Owner and/or Contractor l ---7------ ;------------- ...................................... --------------(Title)------------ - - _............. ......... ..... ............. ze of:llot, location of sysferi;P (Plot plan. showing'si'1W. in relation to�wells, buildings,`ef_c._, can be placed on-reverse-ii-d-,j. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED:BY------ -T 0 ------------------------------------------------------------------------ DATE-----------7_7 REVIEWEDBY----- ------- ----------- ----------------------------------------------------------- DATE---------------- ------ ------------ �4-------------------------------------- BUILDING PERMIT ISSUED$-----------------------I------------------------------•--------------------------------------------• DATE------------------------------------------------------------- Alferafi(;;�s and/or recommendations-------_--.7 ' ' I --------�Z.... ..... -------------- ------ ------- ------------------ ------------- ---------------------------- ----------------------- - -------------:----------------------------------------------- ------------- -----•-----------'- ------------------------------ - ........... --- -- --- ............-------- --------------- ......-------------------:---------- ----------------------------------------------- --------------- ------------------:- - --------------- --- --------------- ------------------------ ----------------------- - --------------------- --------------------- - -------- -- - FINAL INSPECTI V) 'T Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ManteCOr California Tracy,California F.P.12.0.